Provider Demographics
NPI:1619253127
Name:SCHAEDEL, CRYSTAL MASCOLA (PHARM D)
Entity Type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:MASCOLA
Last Name:SCHAEDEL
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12830 WALKER BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28273-8850
Mailing Address - Country:US
Mailing Address - Phone:704-583-2602
Mailing Address - Fax:
Practice Address - Street 1:12830 WALKER BRANCH RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273-8850
Practice Address - Country:US
Practice Address - Phone:704-583-2602
Practice Address - Fax:704-583-2612
Is Sole Proprietor?:No
Enumeration Date:2011-10-28
Last Update Date:2011-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC19221183500000X
TN29714183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist